Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00622
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2012
Parcel: 2S102DD01700
Jurisdiction: Tigard
Site address: 13985 SW FANNO CREEK DR
Project: Landar Subdivision: FINLEY PARK Lot: 1
Project Description: (1) gas furnace installation
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Contractor: PIONEER GAS FURNACE Owner: LANDAR, RICHARD A & DARIA F
2636 NE SANDY BLVD 13985 SW FANNO CR DR
PORTLAND, OR 97232 TIGARD, OR 97224
PHONE: 503 - 249 -5000 PHONE: 503 - 329 -4845
FAX: 503 - 249 -8260
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/03/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/03/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/03/2012 $43.25
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Occupancy Grp:
Stories: •
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or direct questions to /� C�►'` by calling 503.232.1987 or 1.800.332.2344.
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Issued By: /1 /A, j XX//n - 1,f 1 n [([[..i Permittee Signature: oaf AP Pti e 47) Oki
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
9 Approved plans are required on the job site at the time of each Inspection.
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Dec 03 2012 12:26PM HP LASERJET FAX p.1
Mechanical Permit Application ,- „ t ,, i I( i t ti , t rs, i
City of Tigard ■ Received �/
13125 S W Hall Blvd., Ti CEIVED ` f a-13 �- sr P• ID1t N get •oD G 3•.)-
Tigard, OR 9 Plan Review
Phone: 503,71112439 Fax: 503.598. I)at<IHy: • ,
f - i „ r f Inspection Lim 503.639.4175 DEC 0 3 2012 Dare Ready/By:
Internet www.tigard- or.gov Notifiedi hod: � Sea Page 2Inv
Y � S °pp4nmtal Information
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❑ New construction .. ..c ,,. � u hn:>tar -�_ -ih �f1} :!`�.�r. :, �'. ; q�,a..>P „ :;!A;. �.•. .,�.. .,�i pis .'.a:.'- �:.9�:'�'?idt;t
=' Addition/al � t ■ replacement performed. permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other:
mechanical ical materials, equipment, labor, overhead, and profit
; c „ '�i�'F>��� e ; }. ' ; -. Ri7y A: `a� �' �� - - i�Y'}�::�.'r •�i: i.�; i : %. .�: e, �� "i•. �• . :,�: Value • $
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n1- and 2- family dwelling ❑ Commnercialrmdustrial ❑ Accessory ^`r - ,, .' ' '
building ., . >! �,..
❑ Multi family 0 builder - � ` ' For by °'n°etintr are checklist
.. -, m yy'' : . , ❑ Other Description I Qty. Ea. � Total
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? : S r wC_, :w: AD` conditioning
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ob site address: � f 3) '8'5 SW F an nQ C.r ek �(. r .. (>emtires site plan s mat) 46.75
Furnace 100,000 BTU (dm
City/StateiZIP: 1 iAara 0 k _1 / 2.2� xslveus) I 46.75
Q Furnace 100,000+- BTU (ducts ) 54.91
Suite/bldgJapt. no.: 1 Project name: LA D irk Heat pump
(requires site plan showi gg plaeeme) 61.06
Cross street/directions to job site: Ductwork 23.32
Hydronic hot water system ` 23.32
Residential boiler (radiator or 1
hydronic) II 2332
Unit beaten (fuel -type, not elecric), -
in -wall, imp suspended, etc. 46.75
Subdivision: I Lot no.: Flue/vent for any of above I 23.32
Tax map/pancel no -: Other: 23.32
., ,. - > :+ l no.: :;� s. '� 4r. ;.r., Other fuel appliances:
+a', � : . °w "�F4ili�;ti' :,.x :; `•` 4;a' :'.4 "r' „ :»�. , ...i� :i �•S s: ". ":'"•t
s g¢ , a - .r-: .'�: 'i. ' t: • t, �u •:: _, ?� '`. water beater 1
+�':; . *3�S'� :'i.1- _.ire „=;+ r�<<' 1? 4' �`_` �?, h>, 3 :'v7;�:��.��' >_...���` ;y" �.i•, " if "; +Nt ^7,t% � :a :- 2332
L Gas fireplace/insert 33.39
t n 5f�l g fr. T 01 Cie, ., Flue vent for water Seater or gal
&replace 23.32
Leg lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert f 23.32
: fill_1. f lei,'! ,-:... . �.. :,... Chimney/Itner/f ucJv eat
:; :` �� ., _....: ..1. ., :s i +,r 1 23.32
s ->.� y- ic �.Z�
��::�n't� �'.l,� M�
p 7� i 23.32
Name: g�r� and b &rs'LL, Lan die .f Environmental exhaust and ve
Address: same, as (.b o f Range hood/other kitchen
City /State/Z1P: •
equipment _ 33.39
Clothes dryer exhaust 33.39
Phone: Z� -- t f $ [ f C�
Single-duct exhaust (�bt��h toms,
R'i� Lt,S:' i :s`p�7 :;� ..r_,.iJ. - • s,o :,gin•. :;; : i ii- .` " };F,.': <5 ° _ - .� .., toilet compartments, utilit roe )
Pne: (6'6 ) 3 23.32
. . :>, ' . >t- 'Li,� v%^C%• .` ( ,'r fit,. ;.. .. -r :. , .
f >^. _<r i tit JtOe'��W'•'fr''a'••�-W� a`i a>ti?f:: %i rf '. > y : iea��3:1 :c �1Y'-��F :! ;'4 , Altinkraw15 aeefans
�• ,...... «, . _,.- .., �. Fax: ( )
.> f... .�r-.r�' ;, ,t...... rs. P 2332
Business Wane: �( flsD.. I CgTA 1 r2Q GQ
Other: 23.32
p S Fuel PIP*: Contact name: Nit) it xi �� L & b e1 Q 514.15 tar drat four; 5,04 for each addttlooat
Address: 2, ( • p 3 (U y v 65 Sc m p tV . _ Furnace, eta
Gas heat pump
City /State/ZIP; pp f-•{ ) p q743 3 7 wall /suspended /on itheater
Phone: (5.0$) ?4Ct - tS 000 I Fax: : ( ) Water heater
E-mail: 5 Fireplace _
f *, :_ " :i .t J L, :`Ir ''tti1 :'. +'1 . � r, :.: cal;• . ! :, • ; :r.� • , ,5, =n .r; <; Mange ,, ,. rr<`',�S ^iA .r• }.e!Yh5p� :7`+'...s .. ., . , :V :,'�� � .,. ,,,,ri:''j ., =:.t: ;' . } �� }r -l;'', Barbecue
Business name: Clothes dryer (gas)
Other.
Address:
City /State/LIP: �'` ...._ .__. = ?� : - s.�,• :_cry :_�.�
Subtotal ?el �
Phone: ( ) I Fax ( ) M pc-mit fee ($90.00) /
Plan review (2_°% of permit fee)
CCB lie.: N • ik State surcharge (12%of permit fee) f 0 d
1 , /� TOTAL PERMIT FEE 1 OQ. AO
Authorized signature: / ii i /.4 - `_ T his p application spires if s permit is not obtained within 180
, days after it has bib ■ ceeP6ed as complete. ( '
Print name: • 0 f O Date: a 2 , 0 I • Fee methodology set by Tri -Canty Building Industry Service Board
1:\DuadlntWuarit 1MEC-Plr .itApp 03/07n2 440.461 (11/020 oMrwEe) 1